Endoscopic Remission in IBD

Inflammatory bowel disease (IBD) is a chronic condition, which means that people who live with it go through periods of illness and wellness. The goal of treatment for people with Crohn's disease and ulcerative colitis (two of the main forms of IBD) is remission, which for many means a resolution of inflammation and of symptoms. Treatment can take many forms, including medications, surgery, alternative and complementary therapies, and lifestyle changes.

Many people with IBD think of remission as a time of feeling better, with fewer or no symptoms of IBD such as abdominal pain, diarrhea, or blood in the stool. That type of remission is sometimes called clinical remission. However, there is an expanded definition of remission that is becoming increasingly important to patients and healthcare providers that is called endoscopic remission.

person's hands in focus performing Endoscopy
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Different Types of Remission

Think of remission as one big umbrella term, with the various subtypes of remission sitting under it. Healthcare providers will use the different terms to describe remission based on what's going on with the IBD. Not all gastroenterologists will do this in their everyday practice, but at IBD specialty centers or in clinical trials, these different types of remission may be talked about and seen as a goal of treatment. People with IBD who have questions about treatment can gain some insight about their disease by asking about these different types of remission, and if their IBD falls into any of these remission categories:

  • Clinical remission: "Feeling better" with the symptoms of IBD decreasing or even disappearing.
  • Endoscopic remission: During a scope, such as a colonoscopy or a sigmoidoscopy, there's no inflammation in the intestines.
  • Biochemical remission: Tests that are used to measure how IBD affects the blood or stool may show no signs of inflammation being present.
  • Surgical remission: When surgery is used as a treatment and results in a period of fewer or no symptoms. This might sometimes be used to describe people who have had surgery and are not currently experiencing any symptoms and/or inflammation.
  • Histologic remission: Another umbrella term that includes both clinical and endoscopic remission. In addition, when biopsies are taken from the intestines and examined, they don't show any of the characteristics of IBD inflammation.

Endoscopic Remission

People with IBD should have regular testing to monitor how their bodies are responding to treatment. Among the various tests that can be used are endoscopic procedures such as a colonoscopy or an upper endoscopy. During these tests, a healthcare provider can see inside the colon or the small intestine and look for signs of IBD like inflammation, cobblestone sign, scarring, or strictures.

If treatment is working and a gastroenterologist doesn't see anything in the intestines that is typical of IBD, a patient might be considered to be in endoscopic remission. If there were previously parts of the small and large intestine that were inflamed and now they are healing, a patient might be undergoing mucosal healing, which is when the inflammation in the mucosal layer of the intestines begin to heal and return to a healthier state. This type of healing is very important because it could mean that there is less risk of developing complications that could lead to hospitalizations or a lower quality of life.

When It Affects Symptoms

Being in endoscopic remission may or may not mean that the symptoms of IBD are also gone. It has been found that some people with IBD may have intestines that are healing, but they are still having symptoms. If symptoms are ongoing, a gastroenterologist may look for another reason, such as irritable bowel syndrome (IBS), celiac disease, or lactose intolerance. The reverse is also true: Some people may have active inflammation and may not have symptoms.

Why It's Important

It might seem arbitrary to patients: What does endoscopic remission matter if it means that there could still be IBD symptoms? Endoscopic remission is important because the inflammation in the digestive system could lead to bigger problems down the line. If the inflammation is lessened or gone, it means that risks of complications are lowered. Inflammation that goes unchecked could lead to a lower quality of life or more serious intestinal and extra-intestinal complications. This is why endoscopic remission is one important part of achieving remission in IBD.

A Word From Verywell

The change from remission meaning only "lack of symptoms" to having a deeper implication is ongoing and therefore healthcare providers are working towards understanding the differences. Outside of IBD centers, the subtypes of remission might not be readily discussed but it's important to understand if there is inflammation and how much inflammation is present. If inflammation is handled but symptoms are ongoing, that's important to patients, and it's a problem that needs to be addressed through treatment. Talk to your healthcare provider if you have questions about your treatment plan and how you are progressing towards achieving goals in remission.

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  • Cellier C, Sahmoud T, Froguel E, et al. Groupe d’Etudes Therapeutiques des Affections Inflammatoires Digestives. Correlation between clinical activity, endoscopy, severity, and biological parameters in colonic and ileocolonic Crohn’s disease. A prospective multicentre study of 121 cases. Gut. 1994;35:231–235.
  • Neurath MF, Travis SP. Mucosal healing in inflammatory bowel diseases: a systematic review. Gut. 2012;61:1619-1635.

By Amber J. Tresca
Amber J. Tresca is a freelance writer and speaker who covers digestive conditions, including IBD. She was diagnosed with ulcerative colitis at age 16.